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Open Access Research article

Can breastfeeding promote child health equity? A comprehensive analysis of breastfeeding patterns across the developing world and what we can learn from them

Thomas J Roberts1, Emily Carnahan2 and Emmanuela Gakidou3*

  • * Corresponding author: Emmanuela Gakidou gakidou@uw.edu

  • † Equal contributors

Author Affiliations

1 Stanford University School of Medicine, Stanford, CA 94305, USA

2 PATH, Seattle, WA 98121, USA

3 The Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA 98121, USA

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BMC Medicine 2013, 11:254  doi:10.1186/1741-7015-11-254

Published: 4 December 2013

Abstract

Background

In 2010 more than 7.7 million children died before their fifth birthday. Over 98% of these deaths occurred in developing countries, and recent estimates have attributed hundreds of thousands of these deaths to suboptimal breastfeeding.

Methods

This study estimated prevalence of suboptimal breastfeeding for 137 developing countries from 1990 to 2010. These estimates were compared against WHO infant feeding recommendations and combined with effect sizes from existing literature to estimate associated disease burden using a standard comparative risk assessment approach. These prevalence estimates were disaggregated by wealth quintile and linked with child mortality rates to assess how improved rates of breastfeeding may affect child health inequalities.

Results

In 2010, the prevalence of exclusive breastfeeding ranged from 3.5% in Djibouti to 77.3% in Rwanda. The proportion of child Disability Adjusted Life Years (DALYs) attributable to suboptimal breastfeeding is 7.6% at the global level and as high as 20.2% in Swaziland. Suboptimal breastfeeding is a leading childhood risk factor in all developing countries and consistently ranks higher than water and sanitation. Within most countries, breastfeeding prevalence rates do not vary considerably across wealth quintiles.

Conclusions

Breastfeeding is an effective child health intervention that does not require extensive health system infrastructure. Improvements in rates of exclusive and continued breastfeeding can contribute to the reduction of child mortality inequalities in developing countries.

Keywords:
Breastfeeding; Health inequity; Child health; Global burden of disease; Infant feeding